Diagnosis and Management of Aortic Regurgitation

Severity Assessment

The European Society of Cardiology recommends using an integrative, multi-parametric echocardiographic approach to assess the severity of aortic regurgitation, with criteria including vena contracta ≥6 mm, effective regurgitant orifice area (EROA) ≥30 mm², regurgitant volume ≥60 mL, pressure half-time <200 ms, and holodiastolic flow reversal in descending aorta with end-diastolic velocity >20 cm/s 2
Severe AR criteria include vena contracta ≥6 mm, EROA ≥30 mm², regurgitant volume ≥60 mL, pressure half-time <200 ms, and holodiastolic flow reversal in descending aorta with end-diastolic velocity >20 cm/s, as recommended by the European Heart Journal 2

The American College of Cardiology recommends surgery for patients with symptoms attributable to AR, left ventricular ejection fraction ≤55%, or left ventricular end-systolic diameter ≥25 mm/m² body surface area, with a Class I indication for surgery 1
Patients undergoing cardiac surgery for another indication should be considered for concomitant valve surgery even with moderate AR, as recommended by the American College of Cardiology 1

Coronary angiography is mandatory for all elderly patients (particularly >70 years) with severe AR prior to surgery, as recommended by the American College of Cardiology 3
CT imaging can evaluate both coronary anatomy and aortic pathology simultaneously, allowing for combined CABG and aortic valve replacement when indicated, as recommended by the American College of Cardiology 3

Asymptomatic patients with normal LV function require no specific medical therapy, but should undergo surveillance echocardiography every 3-5 years for mild AR and every 1-2 years for moderate AR, as recommended by the American College of Cardiology 1
Asymptomatic patients with severe AR and LV dilation may benefit from vasodilator therapy, such as nifedipine, to potentially prolong the compensated phase and delay surgery, as recommended by the American College of Cardiology 1